Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 14161 | MD |
NPI | 1013220524 |
---|---|
Provider Name | Dr. Tassos John Sfondouris |
First Address | Severna Park, MD 21146-4142 |
Second Address | Severna Park, MD 21146-4142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 26/07/2010 |